| NPI | 1134358997 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01070715A) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11015096A) | 
| Enumeration Date | 2009-07-14 | 
| Last Update Date | 2023-11-27 |